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doi:10.1093/ehjci/jet268 Online publish-ahead-of-print 9 February 2014
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Biventricular ‘salmon roe’ lesions: intracardiac metastasis from oral squamous cell carcinoma Huang Chung Chen, Wei Chieh Lee, and Sarah Chua* Division of Cardiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 123, Ta Pei Road, Niao Sung District, Kaohsiung City 83301, Taiwan
* Corresponding author. Tel: +886 7 731 7123; Fax: +886 7 7322402, Email: [email protected]
Supplementary data are available at European Heart Journal – Cardiovascular Imaging online. Published on behalf of the European Society of Cardiology. All rights reserved. & The Author 2014. For permissions please email: [email protected]
Downloaded from by guest on November 14, 2015
A 43-year-old woman diagnosed with right lower gum squamous cell carcinoma (Stage IVb) presented to the emergency room with a symptom of progressive orthopnoea for 1 week. Twodimensional echocardiography revealed massive pericardial effusion. An M-mode image showed a right ventricle collapse at the diastolic phase (Panel A, white arrow) compatible with cardiac tamponade. A large immobile tumour of 2 × 3 cm in size was located in the apex of the right ventricle and had invaded the myocardium (Panels B and C, white arrow; see Supplementary data online, Movie S1). Multiple intracardiac nodules 1–2 cm in diameter with central hypoechoic density were present in both the right ventricular outflow tract and the left ventricular chamber (Panels D and E, white arrow; see Supplementary data online, Movie S2). These nodules with suspicious central necrosis looked like ‘salmon roes’. Chest contrast computed tomography revealed multiple metastases such as right hilar lymph nodes, lung, liver, and multiple intracardiac nodules in the biventricular chambers (Panel F) prior to cardiac image 3 months earlier. The patient underwent emergent transapical pericardiocentesis and 500 mL bloody serous pericardial effusion was drained. Cytological evaluation was negative for malignant cell; nevertheless, there was an abnormal high level (24.6 ng/mL) of carcinoembryonic antigen in the pericardial fluid. Endocardial biopsy was not implemented as it offers no further benefit and added only harm. Oral cancer is the eighth most common cancer, particularly high among men. The incidence of distant metastases in oral cavity cancer varies from 8 to 17%, and cardiac metastasis from the head and neck had been reported 7–8% of the distant metastasis. We should be aware that oral cancer patients may develop cardiac tamponade because of silent and distant cardiac metastasis. Panels A–F: M-mode echocardiography (A) showing signs of cardiac tamponade with a diastolic collapse of the right ventricle (white arrowhead). Two-dimensional echocardiography at an apical four-chamber view (B and C ) and a ventricular short-axis view (D and E). Multiple masses that looked like ‘salmon roes’ (black arrowhead) are detected in the biventricular chambers. A heterogeneous mass (black star) that encroached in the right ventricular apical myocardium can be observed. In addition, massive pericardial effusion is noted (A–E). Chest contrast computed tomography (F ) showing intracardiac metastasis, including multiple nodules in the left ventricle (black arrowhead) and a mass in the right ventricle near the apex (blank arrowhead) without significant pericardial effusion.
Image focus
IMAGE FOCUS
doi:10.1093/ehjci/jet268 Online publish-ahead-of-print 9 February 2014
.............................................................................................................................................................................
Biventricular ‘salmon roe’ lesions: intracardiac metastasis from oral squamous cell carcinoma Huang Chung Chen, Wei Chieh Lee, and Sarah Chua* Division of Cardiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 123, Ta Pei Road, Niao Sung District, Kaohsiung City 83301, Taiwan
* Corresponding author. Tel: +886 7 731 7123; Fax: +886 7 7322402, Email: [email protected]
Supplementary data are available at European Heart Journal – Cardiovascular Imaging online. Published on behalf of the European Society of Cardiology. All rights reserved. & The Author 2014. For permissions please email: [email protected]
Downloaded from by guest on November 14, 2015
A 43-year-old woman diagnosed with right lower gum squamous cell carcinoma (Stage IVb) presented to the emergency room with a symptom of progressive orthopnoea for 1 week. Twodimensional echocardiography revealed massive pericardial effusion. An M-mode image showed a right ventricle collapse at the diastolic phase (Panel A, white arrow) compatible with cardiac tamponade. A large immobile tumour of 2 × 3 cm in size was located in the apex of the right ventricle and had invaded the myocardium (Panels B and C, white arrow; see Supplementary data online, Movie S1). Multiple intracardiac nodules 1–2 cm in diameter with central hypoechoic density were present in both the right ventricular outflow tract and the left ventricular chamber (Panels D and E, white arrow; see Supplementary data online, Movie S2). These nodules with suspicious central necrosis looked like ‘salmon roes’. Chest contrast computed tomography revealed multiple metastases such as right hilar lymph nodes, lung, liver, and multiple intracardiac nodules in the biventricular chambers (Panel F) prior to cardiac image 3 months earlier. The patient underwent emergent transapical pericardiocentesis and 500 mL bloody serous pericardial effusion was drained. Cytological evaluation was negative for malignant cell; nevertheless, there was an abnormal high level (24.6 ng/mL) of carcinoembryonic antigen in the pericardial fluid. Endocardial biopsy was not implemented as it offers no further benefit and added only harm. Oral cancer is the eighth most common cancer, particularly high among men. The incidence of distant metastases in oral cavity cancer varies from 8 to 17%, and cardiac metastasis from the head and neck had been reported 7–8% of the distant metastasis. We should be aware that oral cancer patients may develop cardiac tamponade because of silent and distant cardiac metastasis. Panels A–F: M-mode echocardiography (A) showing signs of cardiac tamponade with a diastolic collapse of the right ventricle (white arrowhead). Two-dimensional echocardiography at an apical four-chamber view (B and C ) and a ventricular short-axis view (D and E). Multiple masses that looked like ‘salmon roes’ (black arrowhead) are detected in the biventricular chambers. A heterogeneous mass (black star) that encroached in the right ventricular apical myocardium can be observed. In addition, massive pericardial effusion is noted (A–E). Chest contrast computed tomography (F ) showing intracardiac metastasis, including multiple nodules in the left ventricle (black arrowhead) and a mass in the right ventricle near the apex (blank arrowhead) without significant pericardial effusion.
